Can People With Advanced Prostate Cancer Enroll In Clinical Trials
Major organizations such as the National Comprehensive Cancer Network recommend this course of action for all cancer patients. Researchers are exploring several new ways of diagnosing, monitoring, and treating prostate cancer. Clinical trials test the safety and effectiveness of these new methods and treatments. There are risks and limitations in every clinical trial. For example, you may be assigned to the control group, and not get the new medicine. In that case, the control medicine is the best therapy already available. Placebo or ineffective treatment is rarely if ever used anymore, and if it will be used in the trial, you would be informed. Keep in mind that the new medicine under investigation in the clinical trial may not work. But clinical trials also offer early access to new treatments.
You can find out more about clinical trials by asking a medical oncologist, inquiring at an academic medical center, or browsing a clinical trials listing service. The National Institutes of Health lists clinical trials at www.clinicaltrials.gov.
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Surgically Removing The Prostate Gland
A radical prostatectomy is the surgical removal of your prostate gland. This treatment is an option for curing prostate cancer that has not spread beyond the prostate or has not spread very far.
Like any operation, this surgery carries some risks, such as urinary incontinence and erectile dysfunction.
In extremely rare cases, problems arising after surgery can be fatal.
Its possible that prostate cancer can come back again after treatment. Your doctor should be able to explain the risk of your cancer coming back after treatment, based on things like your PSA level and the stage of your cancer.
Studies have shown that radiotherapy after prostate removal surgery may increase the chances of a cure, although research is still being carried out into when it should be used after surgery.
You may want to ask your doctors about storing a sperm sample before the operation so it can be used later for in vitro fertilisation .
Cancer can spread through tissue, the lymph system, and the blood:
- Tissue. The cancer spreads from where it began by growing into nearby areas.
- Lymph system. The cancer spreads from where it began by getting into the lymph system. The cancer travels through the lymph vessels to other parts of the body.
- Blood. The cancer spreads from where it began by getting into the blood. The cancer travels through the blood vessels to other parts of the body.
Favorite Apps Products And Gadgets
With a simple tap, youll receive information about personalized prostate cancer treatment options to help manage your care. This free app includes questions to ask your doc, calendars to keep track of your appointments, and videos that highlight helpful resources. Downloading it is a great way to stay on top of your cancer!
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Stage Iv Prostate Cancer Prognosis
Prostate cancers detected at the distant stage have an average five-year survival rate of 28 percent, which is much lower than local and regional cancers of the prostate. This average survival rate represents stage IV prostate cancers that have metastasized beyond nearby areas to lymph nodes, organs or bones in other parts of the body.
Staging Spread And Survival Rates
As with all cancers, doctors use the term stage to describe the characteristics of the primary tumor itself, such as its size and how far prostate cancer has spread when it is found.
Staging systems are complicated. The staging system for most cancers, including prostate cancer, uses three different aspects of tumor growth and spread. It’s called the TNM system, for tumor, nodes, and metastasis:
- T, for tumor describes the size of the main area of prostate cancer.
- N, for nodes, describes whether prostate cancer has spread to any lymph nodes, and how many and in what locations.
- M, for metastasis, means distant spread of prostate cancer, for example, to the bones or liver.
Using the TNM system, each man’s prostate cancer can be described in detail and compared to other men’s prostate cancer. Doctors use this information for studies and to decide on treatments.
As far as survival rates for prostate cancer go, however, the staging system is pretty simple. As we’ve mentioned, in terms of survival rates, men with prostate cancer can be divided into two groups:
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Why Is Prostate Cancer So Treatable
Prostate cancer is a malignancy that occurs in the male reproductive system, specifically in the small, walnut-shaped prostate gland that surrounds the urethra just below the bladder. Generally, this type of cancer grows slowly, and advancements in screening methods have led to an increase in cases of early detection. In fact, according to the American Society of Clinical Oncology, most cases are detected before the cancer spreads to other parts of the body. This makes prostate cancer easier to treat.
One of the most common screening methods involves testing for prostate-specific antigen levels in a mans blood. Antigens are molecules that can stimulate the bodys immune system to produce antibodies. High PSA levels can be a sign of prostate cancer, although there are other prostate conditions that can cause high PSA levels as well.
Another way to screen for prostate cancer is with a digital rectal exam , a screening thats routinely performed for men 55 and older. For this exam, the physician inserts a gloved, lubricated finger into the rectum to feel the back part of the prostate gland where cancers often begin. During a DRE, the physician is searching for bumps or hard areas on the prostate that could be signs of cancer.
- Frequent urination, especially at night
- Difficulty starting or stopping urination
- Sudden erectile dysfunction
Hormone Therapy For Prostate Cancer
Also known as androgen suppression therapy, the purpose of hormone therapy is to mitigate the influence of any prostate cancer. What happens is that prostate cancer cells are feeding on male hormones in order to grow. Using hormone therapy, the body puts a stop on supplying cancer with what it requires in order to grow.
Nonetheless, hormone therapy is not a cure for prostate cancer. Doctors can recommend this procedure when the cancer has spread too far or before chemotherapy in order to shrink the tumor and maximize the efficiency of the treatment.
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Impact Of Age On Treatment
The rising number of men diagnosed with prostate cancer is a result of increasing life expectancy as well as the current practice of screening by prostate-specific antigen blood tests. Besides PSA and Gleason score, age is considered a key prognostic factor in treatment decision making. Although organ-confined disease can be cured by radical prostatectomy and full-dose local radiation therapy, treatment options for advanced- stage disease remain palliative. They include active surveillance, or watchful waiting, early versus delayed hormonal therapy to control disease progression, and continuous or intermittent androgen deprivation. Observational studies of older men with early stage disease have suggested conservative management as a viable option.,
Chodak and associates evaluated 828 men who were managed expectantly in a series of nonrandomized trials. Median follow-up was approximately 6.5 years. Patients with poorly differentiated cancers had a 10-fold increased risk of death from prostate cancer as compared with men showing highly differentiated prostate cancer. A 5-year disease-specific survival of only 34% was found in men with poorly differentiated prostate cancer. In contrast a 5-year disease-specific survival of 87% was described in men with well-or moderately differentiated cancers.
Prostate Cancer Treatment Options: What Are They
Prostate cancer is, most often, a slow-growing cancer.
For some men, prostate cancer causes no symptoms or long-term issues, so treatment isn’t necessary.
In these cases, doctors may recommend active surveillance. That is, they’ll keep an eye on the development of the tumor using various tools and tests, including:
- Digital rectal exams
- Transrectal ultrasounds
- Prostate biopsies
Men who require treatment for their condition are most often treated with surgery, radiation therapy, hormone therapy, or a combination of these modalities.
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Prostate Cancer Survival Rates: What They Mean
As cancer diagnoses go, prostate cancer is often a less serious one. Prostate cancer is frequently slow-growing and slow to spread. For many men, prostate cancer is less serious than their other medical conditions.
For these reasons, and possibly because of earlier detection of low-grade prostate cancers, prostate cancer has one of the highest survival rates of any type of cancer. WebMD takes a look at prostate cancer survival rates and what they mean to you.
Radiotherapy For Prostate Cancer
30% of patients diagnosed with prostate cancer in England during 2013-2014 had curative or palliative radiotherapy, as part of their primary cancer treatment. This includes patients who had radiotherapy alone, and those who also had other treatments such as surgery to remove the tumour, or chemotherapy.
The proportion of prostate cancer patients having radiotherapy is strongly influenced by stage at diagnosis.
Other factors are also important, such as whether the patient is generally well enough to tolerate the treatment, the patients age, and their own treatment preference.
Prostate Cancer , Percentage of Patients Receiving Radiotherapy in the 12 Months After Diagnosis, Males, All ages, England, 2013-2014
| Stage at diagnosis |
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Overview Of The Staging System
After a thorough assessment by your oncologist, your cancer will be assigned a stage between I and IV. Prostate cancer stages are based on the American Joint Committee on Cancer TNM system. Using the TNM system, your oncologist:
- Examines the tumor
- Determines if the cancer has spread to any lymph nodes
- Assesses whether the cancer has metastasized
- Considers the prostate-specific antigen level from blood testing
- Assigns a grade group based on how abnormal the cancer appears under a microscope
With this information in mind, you can better understand how stages are assigned and what they mean for patients in general.
Study Population And Characteristics
During the study period, 373 patients diagnosed with IR prostate cancer were treated in the Radiation Oncology Department of the CSMC 196 patients were treated with RT with concomitant short-term ADT, and 177 patients with RT alone. Table shows population and treatment-related characteristics of patients treated with RT and short-term ADT and RT alone. Patients in both arms were similar in terms of mean age at time of therapy, Gleason score at biopsy, fiducials implants, RT treatment modality , and the Charlson comorbidity score. The mean follow-up time was 55.9±37.2months and did not significantly differed between the two treatment groups. However, compared to patients treated with RT alone, patients treated with a combination of RT+ ADT had significantly more unfavorable risk factors including: higher PSA levels before RT treatment, more intermediate-risk risk factors, and a higher percent of positive cores on biopsy. Moreover, patients receiving RT and ADT had higher T-stage, however the difference did not reach statistical significance . The vast majority of patients in both groups did not receive pelvic lymph node RT , and a higher fraction of patients receiving RT and ADT were administered pelvic lymph node RT.
Table 1 Patient characteristics and treatment
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How Is Active Surveillance Done
Although the protocol can vary, recommendations for active surveillance generally call for routine PSA tests and prostate biopsies to check for any indication that the cancer might be growing.
For example, patients at Montefiore Health System in New York City get a PSA test every 36 months, at least initially, and an MRI-guided biopsy a year after diagnosis, said Kara Watts, M.D., a urologist at the hospital who specializes in treating prostate cancer but was not involved in the study.
After the initial PSA tests and biopsy, how often they are performed depends largely on the patients particular situation, Dr. Watts explained.
We have a flexible protocol, particularly for people at both ends of the spectrum, she continued. For a man in his 70s and a life expectancy of 510 years , she said, additional PSA tests or biopsies may only be conducted every few years or only if he has symptoms. An otherwise healthy man in his 50s, on the other hand, will usually continue to have PSA tests and MRI-guided biopsies on a schedule similar to the initial protocol.
At the NIH Clinical Center, where Dr. Parnes sees patients, in addition to routine PSA testing, MRI-guided biopsies are used to help inform decisions around whether to pursue active surveillance and as part of the surveillance protocol.
How Prostate Cancer Staging And Risk Stratification Affect Treatment Options
Your treatment choices are determined by several factors, including your cancers stage, aggressiveness and assigned risk stratification . Your age and current general health condition may also affect your choices.
Prostate cancer staging
Prostate cancer staging determines whether the cancer is confined to the prostate gland or whether theres evidence of metastasis, meaning its spread to other areas of the body.
Tools and methods to determine staging may include the prostate-specific antigen test, the digital rectal examination , the Gleason score and the American Joint Committee on Cancer TNM system, which provides information on the tumor, lymph node involvement and metastasis of a cancer. Imaging tests, such as a PET/CT scan, may also help determine your cancers stage.
The four stages of prostate cancer are subdivided into more precise categories, but we generally refer to three groups that indicate how far the cancer has spread:
Localized, meaning theres no indication that the cancer has spread beyond the prostate
Regional, meaning theres evidence of cancer cells in nearby lymph nodes or tissue
Distant, meaning theres evidence the cancer has spread to other organs or body parts farther from the prostate
Almost 90 percent of prostate cancers are diagnosed at the localized or regional stage. The five-year relative survival rate for men diagnosed with prostate cancer at these stages is nearly 100 percent.
Prostate cancer risk assessment
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Outlook For Men With Advanced Prostate Cancer
While it isnt possible to cure advanced prostate cancer, treatments can help keep it under control, often for several years. Treatments will also help manage any symptoms, such as pain.
Some men may not respond well to one treatment, but may respond better to another. And when your first treatment stops working, there are other treatments available to help keep the cancer under control for longer.
Help Getting Through Cancer Treatment
People with cancer need support and information, no matter what stage of illness they may be in. Knowing all of your options and finding the resources you need will help you make informed decisions about your care.
Whether you are thinking about treatment, getting treatment, or not being treated at all, you can still get supportive care to help with pain or other symptoms. Communicating with your cancer care team is important so you understand your diagnosis, what treatment is recommended, and ways to maintain or improve your quality of life.
Different types of programs and support services may be helpful, and can be an important part of your care. These might include nursing or social work services, financial aid, nutritional advice, rehab, or spiritual help.
The American Cancer Society also has programs and services including rides to treatment, lodging, and more to help you get through treatment. Call our National Cancer Information Center at 1-800-227-2345 and speak with one of our trained specialists.
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Another type of prostate issue is chronic prostatitis, or chronic pelvic pain syndrome. This condition causes pain in the lower back and groin area, and may cause urinary retention. Symptoms include leaking and discomfort. In severe cases, a catheter may be required to relieve the symptoms. If the problem is unresponsive to other treatments, your doctor may suggest a surgical procedure. If these do not work, your symptoms could progress and become chronic.
An acute bacterial infection can cause a burning sensation. Inflammation of the prostate can affect the bladder and result in discomfort and other symptoms. This is the most common urinary tract problem in men under 50, and the third most common in men over 65. The symptoms of acute bacterial prostatitis are similar to those of CPPS. Patients may experience a fever or chills as a result of the infection.
Who Can I Contact If I Have Personal Concerns About My Treatment
Many hospitals and clinics have a staff social worker who can help you during your treatment. Check with your doctor to see if this is available to you.
The social worker can discuss any emotional issues or other concerns about your treatment or your personal situation and provide information about resources. The social worker can also discuss housing or transportation needs if necessary.
People dealing with certain medical issues find it helpful to share experiences with others in the same situation. Your doctor can provide a list of support groups if you are interested. Your social worker can provide additional information, and you can look online for support group resources.
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Where Do These Numbers Come From
The American Cancer Society relies on information from the SEER database, maintained by the National Cancer Institute , to provide survival statistics for different types of cancer.
The SEER database tracks 5-year relative survival rates for prostate cancer in the United States, based on how far the cancer has spread. The SEER database, however, does not group cancers by AJCC TNM stages . Instead it groups cancers into localized, regional, and distant stages.
- Localized: There is no sign that the cancer has spread outside the prostate.
- Regional: The cancer has spread outside the prostate to nearby structures or lymph nodes.
- Distant: The cancer has spread to parts of the body farther from the prostate, such as the lungs, liver, or bones.